Debbi Marais

Current and planned research on agriculture for improved nutrition: A mapping and a gap analysis

Despite the clear potential for agricultural change to improve nutrition in low and middle income countries (LMIC), the evidence base for this relationship is poor. Recent systematic reviews of studies which have evaluated agricultural interventions for improved nutrition reveal little strong evidence of impact and a need for more and better designed research. The study aimed to assist the development of a more coherent framework for research in this area to ultimately improve the overall quality of research on agriculture for improved nutrition. A conceptual framework linking agriculture, food, and nutrition was developed by an expert panel making use of existing concepts for interactions between agriculture and health. It was used to define the domain of research on agriculture for improved nutrition, to establish inclusion criteria for research to be considered, and to characterise that research in a comparative way, relative to the different impact pathways. Mapping of current and planned research projects using snowballing and following specified inclusion and exclusion criteria was conducted from information obtained from the informants themselves and/or from project websites. A gap analysis was conducted to identify more poorly researched areas. The study characterized 151 research projects, most of which are part of broader research programmes. A significant majority concern Sub-Saharan Africa, with a particular focus on nutritional impacts on women and children. Current research is of a range of types, with the majority (58%; n=88) involving research on some form of active intervention into agriculture and the rest (n=63) involving research on existing datasets and 3 systematic reviews. The gap analysis on 100 of the projects with sufficient information identified eight clear research gaps: Full pathway of change especially not value chain; Indirect effect of changes in agriculture on nutrition; Effects of agricultural policy on nutrition; Governance, policy processes and political economy for development of agriculture-for-nutrition policies and programmes; Development of methodologies and appropriate metrics; Consumers as a broader target group especially rural workers and non-rural populations; Rural and urban poor at risk from nutrition-related noncommunicable diseases and Cost-effectiveness. Most projects did not consider the value chain and few measure nutritional status. Very few projects considered indirect effects acting through economic outcomes. There is limited research underway on the development of new methodologies and metrics to measure effects along the different impact pathways, or to evaluate cost effectiveness of interventions.

Agriculture for Improved Nutrition: The Current Research Landscape

Background Concern about food security and its effect on persistent undernutrition has increased interest in how agriculture could be used to improve nutritional outcomes in developing countries. Yet the evidence base for the impact of agricultural interventions targeted at improved nutrition is currently poor. Objective To map the extent and nature of current and planned research on agriculture for improved nutrition in order to identify gaps where more research might be useful. Methods The research, which was conducted from April to August 2012, involved developing a conceptual framework linking agriculture and nutrition, identifying relevant research projects and programs, devising and populating a “template” with details of the research projects in relation to the conceptual framework, classifying the projects, and conducting a gap analysis. Results The study identified a large number of research projects covering a broad range of themes and topics. There was a strong geographic focus on sub-Saharan Africa, and many studies were explicitly concerned with nutritional impacts on women and children. Although the study revealed a diverse and growing body of research, it also identified research gaps. Few projects consider the entire evidence chain linking agricultural input or practice to nutritional outcomes. There is comparatively little current research on indirect effects of agriculture on nutrition, or the effect of policies or governance, rather than technical interventions. Most research is focused on undernutrition and small farmer households, and few studies target consumers generally, urban populations, or nutrition-related non-communicable diseases. There is very little work on the cost-effectiveness of agricultural interventions. Conclusions On the basis of these findings, we make suggestions for research investment and for broader engagement of researchers and disciplines in developing approaches to design and evaluate agricultural programs for improved nutrition.

Assessment of the quality of interaction in distance learning programmes utilising the Internet (WebCT) or interactive television (ITV)

Introduction  This study focuses on the quality of interaction in interactive TV (ITV), WebCT bulletin boards (BBs) and chat rooms (CRs) and addresses the question of how effectively new collaborative electronic technologies have been married with new pedagogical ideas to create effective learning for distance education students.

Factors influencing high socio-economic class mothers’ decision regarding formula-feeding practices in the Cape Metropole

Abstract The aims of the study were to identify the reasons why high socio-economic class women in the Cape Metropole decide not to breast-feed; to evaluate whether the type and volume of infant formula selected by the mother was appropriate for her infant’s current age and to identify the factors that influence the decision-making process when deciding which infant formula to feed her infant. An observational descriptive study with consecutive sampling was utilised. Data of 55 mothers with infants aged 0 to 6 months that were not currently breast-fed was captured in day care centres and private clinics situated in the Cape Metropole. Data was collected by means of a self-administered questionnaire available in Afrikaans and English. The majority of mothers (80%) decided only after the birth of their infant to rather opt for formula feeding. Evident factors that were identified as barriers to breast-feeding include a lack of knowledge and experience (38%) as well as a lack of facilities at public places (75%) and at work (71%) to breast-feed. Perceived benefits of infant formula included that the father could help with the workload (67%) and does not feel left out (38%), the mother knows what volume of milk is received (84%) and the convenience if the mother is working (64%). The mothers were overall not concerned about possible side-effects of breast-feeding and did not feel that their breasts were physically not of optimal physiology to breast-feed. One of the greatest challenges to support, protect and promote breast-feeding is to ensure that information sources give scientifically correct information to the uninformed or information-seeking mother in a standardised and positive manner.

Knowledge, attitudes and practices of women regarding the prevention of mother-to-child transmission (PMTCT) programme at the Vanguard Community Health Centre, Western Cape – a pilot study

Objective: The aim of the study was to determine the knowledge, attitudes and practices of women regarding the prevention of mother-to-child transmission (PMTCT) programme at a community health centre (CHC).

Maternal obesity in Africa: a systematic review and meta-analysis

Background Maternal obesity is emerging as a public health problem, recently highlighted together with maternal under-nutrition as a ‘double burden’, especially in African countries undergoing social and economic transition. This systematic review was conducted to investigate the current evidence on maternal obesity in Africa. Methods MEDLINE, EMBASE, Scopus, CINAHL and PsycINFO were searched (up to August 2014) and identified 29 studies. Prevalence, associations with socio-demographic factors, labour, child and maternal consequences of maternal obesity were assessed. Pooled risk ratios comparing obese and non-obese groups were calculated. Results Prevalence of maternal obesity across Africa ranged from 6.5 to 50.7%, with older and multiparous mothers more likely to be obese. Obese mothers had increased risks of adverse labour, child and maternal outcomes. However, non-obese mothers were more likely to have low-birthweight babies. The differences in measurement and timing of assessment of maternal obesity were found across studies. No studies were identified either on the knowledge or attitudes of pregnant women towards maternal obesity; or on interventions for obese pregnant women. Conclusions These results show that Africas levels of maternal obesity are already having significant adverse effects. Culturally adaptable/sensitive interventions should be developed while monitoring to avoid undesired side effects.

Effects of probiotics on child growth: a systematic review

BackgroundChild undernutrition has short and long term consequence for both individuals and society. Previous studies show probiotics may promote child growth and have an impact on under-nutrition.MethodsA systematic review of the literature was carried out on three electronic databases to assess evidence. The outcome measured was change in weight or height. A narrative analysis was conducted due to heterogeneity of included studies.ResultsTwelve studies were included in the review of which ten were randomised controlled trials. A total of 2757 children were included, with 1598 from developing countries. The studies varied in type and quantity of probiotics given, duration of interventions, characteristics of participants, setting and units of outcome measures. Overall, five studies found a positive effect of probiotics on child growth. All five were conducted in developing countries with four studies conducted in mostly under-nourished children and one in well-nourished children. No significant effect on growth was found in the seven studies that were conducted in developed countries.ConclusionThe limited evidence suggests that probiotics have the potential to improve child growth in developing countries and in under-nourished children. More research is needed to explore this further.

What overweight women want from a weight loss app: a qualitative study on arabic women.

Background Overweight and obesity are international public health issues. With mobile and app use growing globally, the development of weight loss apps are increasing along with evidence that interventions using technology have been effective in the treatment of obesity. Although studies have been conducted regarding what content health professionals would recommend within weight loss apps, there are limited studies that explore users’ viewpoints. There is specifically a paucity of research that takes the cultural background of the user into consideration, especially in Middle Eastern countries where the lives and weight loss intervention needs of women not only vary vastly from the West, but the obesity rate is also increasing exponentially. Objective The current study sought to explore the proposed features of an Arabic weight loss app by seeking the experiences and opinions of overweight and obese Saudi Arabian users in order to design a mobile phone app to fit their needs. Methods Focus group discussions were conducted with a purposive sample of volunteer overweight and obese Saudi women (BMI ≥ 25) who were older than 18 years and who owned a mobile phone. The most common Arabic and English weight loss mobile apps were downloaded to initiate dialogue about app usage and to get their opinions on what an ideal weight loss app would look like and the features it would include. All transcribed, translated discussions were thematically analyzed, categorized for each of the main topics of the discussion, and specific quotations were identified. Results Four focus groups were conducted with a total of 39 participants. Most participants owned an Android mobile phone and only a few participants were aware of the availability of health-related apps. Barriers to weight loss were identified including: motivation, support (social and professional), boring diets, customs, and lifestyle. Diverse themes emerged as suggestions for an ideal weight loss app including: Arabic language and culturally sensitive; motivational support and social networking; dietary and physical activity tools; and a tailorable, user-friendly interface. Conclusions This study identifies weight loss app features from the users’ perspective, which should be considered in the development of a weight loss app for this population.

Nutritional health of young children in South Africa over the first 16 years of democracy

Objectives. Malnutrition among young children is a major health problem in post-apartheid South Africa. Despite implementation of numerous health and nutrition programmes, these extensive efforts to alleviate the situation have not been adequately reviewed. Methods. We provide an overview of various aspects of the current nutritional health status of young children. The reviewed data are from the time period 1994 - 2010, and were collected from literature databases and official reports, as well as our own experience with field research in various urban and rural parts of the country. Results. Both smaller province-based studies as well as three large nationwide surveys conclude that many young South African children have inadequate nutritional status. Rates of stunting, micronutrient deficiencies and hunger and food insecurity are all unacceptably high. Coexisting HIV/AIDS and tuberculosis add to this burden. A gradual transition to a westernised diet characterised by energy-dense food has led to a worrying increase in overweight and obesity. Conclusion. A major challenge for the South African health authorities is still the fight against childhood undernutrition and hunger, which in turn are rooted in poverty and social inequalities. The double burden of disease adds to the scale and complexity of this challenge.

Assessment of nutritional status of older people in homes for the aged in the Somerset West area

Owing to the paucity of data in South Africa regarding older people (>60 years) living in homes for the aged, the aim of this study was to evaluate their nutritional status in a convenient sample of homes for the aged (N=4) in the Somerset West area. In the descriptive, cross-sectional study, nutritional status was evaluated by using the Mini Nutritional Assessment (MNA) as well as traditional anthropometric measurements independently. Nutrient intake was determined using menu, plate wastage and food acceptability data. The study population consisted of 53 male and 157 female older people with a mean age of 76.8 years (SD 10.6). The mean body mass index BMI was 25.6 (SD 5.17). According to the MNA, 6% of the older people were malnourished, and 47% were at risk for malnutrition. Had the independent anthropometric measurements been used, fewer older people would have been identified as at risk of malnutrition. After correcting for plate wastage, the average energy consumption was 6 963 kJ. Nutrient values 50%) were the starchy menu items, cooked vegetables and lunch protein dishes. The MNA is a valuable instrument in identifying older people at risk of malnutrition, thus allowing for early intervention. There was a relationship between malnutrition and lower energy intake, emphasising the need for meticulous menu planning and monitoring of food consumption, and the need for addressing specific micronutrients.